Decisions like this are made in every hospital, every day.
The whole “death panel” thing implied that decisions were going to be made remotely by people who had never met the patient or their family.
An ambulance has 2-3 times the number of workers, so if an “ambulance ride” costs 2-3 times what a taxi trip costs, that sounds like a pretty good deal.
There are lots of good reasons to cover such care, but I’m not sure cutting health care costs is one of them. Lots of those destitute people will just die early, which represents a savings to the medical system. Someone who gets no care and dies a lingering death at the age of 55 after some catastrophe will probably be cheaper to cover than someone who gets 90 years of preventive care and then has their lingering death then.
A MRI machine can cost well north of a million dollars. The one in our local hospital cost about $3 million. And the specially constructed MRI suite built to house the machine does not come cheap. That has to be amortized over the life of the machine, but each scan is going to pay its share of the cost for the machine and it is a sizable chunk.
A fully outfitted ambulance has a lot of medical hardware that a taxi does not have. Just try getting an EKG from your cabbie while on way to the hospital.
There are expectations and standards within the emergency medical services that push for certain response times for high priority calls. This may result in two ambulances spread out to cover an area in order to reach that heart attack patient within 8 minutes where only one Uber driver could provide a similar number of trips per day but with the potential for longer response times.
Costs of the ambulance, its upkeep, and wages for the staff are paid on a fee for service basis in many communities. As a result ambulance charges are high. And unfortunately some people abuse the system and request an ambulance for even minor ailments.
Developing a social awareness and expectation that people should seek medical care at a suitable level would help. There are multi-tier models which include an ER, Urgent Care, Walk in clinic, and regular Primary Care. Here is an example that includes the types of care available at each level.
Take a kid who was playing basketball and landed wrong. She ends up with a painful ankle. Her care can suitably be provided at the Urgent Care level by a Physician’s Assistant. Multiply those sorts of incidents a hundredfold over a day or two and the Urgent Care clinic takes a significant burden off the Emergency Specialist doctors at the ER at the hospital. That potentially lets the ER get by using lower number of highly specialized staff.
What?
Aside from the extremely high cost of end of life only care, how can you not understand the cost savings of simply paying to cover insurance premiums (for those in need!), rather than pay their actual healthcare costs?
Surely you can understand that your premiums are much cheaper to cover than to pay out of pocket for actual full cost, right?
HOW IS THIS NOT SELF EVIDENT TO EVERYONE?
So why wouldn’t that be article one of ANY healthcare bill? Huge savings, immediately realized while leaving every other bit unchanged.
(Y’know, if it was REALLY about saving money, and NOT about disenfranchising the unworthy!)
How is it not self evident to everyone that the insurance companies take a cut as their profit?
It is cheaper to pay the cost of treatment for everyone as a group than it is to pay insurance premiums for them. Sure certain individuals will have much higher medical expenses than what an insurance premium would have cost, but many more will have lower medical expenses than what an insurance premium would have cost. So long as you have a sufficiently large group to spread the risk that is how insurance works.
So not just ANY healthcare bill would result in savings. You need to squeeze the insurance companies’ profit out of the equation.
Again, WHAT?
A single Dr or emerg visit, for the most minor thing, FAR exceeds the cost of an insurance premium. How is it possible to believe that for, ‘many more’, it would be cheaper to pay their actual hospital costs than an insurance premium?
Got any proof for what you claim? Especially the MANY MORE part?
Come on, YOU buy health insurance BECAUSE it’s a BIG savings over full out of pocket Healthcare expenses. Why would it not be so for anyone else?
there is no objective reason for this to be the case in a rationalization of your health care system. You spend almost two times the amounts of any other developed country yet achieve worse outcomes in health than any other wealthy democratic state.
There is clearly the large amount of inefficencies in your system.
Define the cost of an insurance premium. Seriously. I pay about $400 a month for my family insurance coverage and my employer pays at least another $20K ( according to my 2016 W2). There have been many years when paying out of pocket would have cost less than the full $25K cost of insurance coverage. There have even been years where paying out of pocket would have cost less than just my share of the premiums.
I don’t have health insurance because it’s a big savings over out of pocket. I have health insurance for two reasons. First, my employer will not give me the $20K it contributes if I turn down the insurance. Second, the cost of my insurance coverage is predictable, while the cost of health care is not. This could be the normal year where my medical costs are far less than $25K - or it could be the one with a million dollar catastrophe. Much like in most years paying out of pocket would be cheaper than my homeowner’s insurance - right up until the year my house burns down.
Think about it logically - for a particular person in a particular year, paying for insurance premiums may well be less expensive than paying out of pocket. But over a large group of people, whether that group is customers of a particular insurance company or society as a whole, that can’t work. The customers of an insurance company have to pay enough in premiums to
- Cover all the medical costs paid by that insurance company
- Pay the overhead of the insurance company
and possibly provide a profit to the insurance company
And that means that some will pay more in premiums than their out of pocket cost would have been- otherwise where would you get the money to pay the million dollar bill for the people who paid $20K in premiums?
I consider myself more libertarian than conservative. At any rate, here would be my ideal system:
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Get the federal government completely out of the healthcare business. If there is to be government involvement in healthcare, it should be at the state level, not the federal level.
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If you’re poor you can sign up for “free” healthcare via the state. You will receive basic healthcare, but you will not be able to choose your doctor, wait times will be longer, etc.
This is an unfortunate disincentive to any state to produce a really good system: sick people would migrate to that state in large numbers.
You’re looking at the common cases. Taken as a whole, the outflowing cost of all peoples’ healthcare has to be covered by the inflowing premiums of all who pay. Right? Otherwise, if not, the insurance company eventually goes out of business.
People buy insurance, unless otherwise mandated, because it is is a good bet. They choose to buy because they’re willing to bet that the cost of the premium is less than the cost of the benefit, if it’s needed.
ETA: The main point is that the cost of healthcare has to covered from somewhere. You think that the cost of premiums was far lower than the one time you needed that emergency procedure, and it is, but for the many people who don’t need the procedure, any procedure, it’s not a good bet.
And what incentivizes anyone, generally speaking, to do a good job? Profit. Take profit out of the equation, and the desire to exceed dwindles.
It is just basic economics of insurance. Really not confusing at all.
An insurance premium is a BIG savings for me over the price of paying a an ER visit out of pocket, of course. But I don’t have an ER visit every month, much less every year. But I do have an insurance premium every month. And every month I do not have a doctor’s appointment or ER visit, or other eligible medical expenses I am guaranteed to “lose” my premium.
Insurance is spreading the risk that I will have medical expenses by pooling my premium with the premium of others. Then out of that pool the insurance company pays claims as well as its operating costs and it takes a profit.
Insurance companies are not charities so they set premiums using actuarial data so that they expected amount they will pay in claims for the group as a whole is always less than the premiums collected from the group as a whole by a large enough margin that they will turn a profit.
The US Government could theoretically choose to cover health care costs for everyone directly out of some sort of tax revenue, effectively cutting the insurance companies out of the picture.
It is still the same general idea as insurance, pooling risk. It is not so important that one particular person or group has health care expenses that exceed the taxes that individual to group pays into the system. But for everyone one person who runs up a $1 million in medical care there must be many, many others who pay in more than they get out in services.
So the government would want to set the tax rate at an appropriately level so that overall the tax revenue would be roughly equal to claims paid for the group as a whole.
But the government would not necessarily be under the same pressure to collect enough to turn a profit where insurance companies do get that pressure from share holders. So theoretically if government could administer such a system in a somewhat efficient manner they could do it for a lower per capita cost than the current private insurance company run system by simply not needing to collect a profit for their efforts.
Virtually everyone will need expensive healthcare eventually. So what do unscrupulous people do? Not buy insurance until they need it? What happens then? They contact insurance companies and the insurance company says, ‘Ah. I see you have a preexisting condition. Sure, we’ll cover you. Your premiums will be $100,000 per month.’ Is that a good bet?
The point was that the cost of healthcare has to come from somewhere. Insurance companies pay for that cost, and they get paid by the premiums.
I see that as a good thing. Sort of a “reverse competition.”
Oh, like Medicare. This is a good idea. Why has no one thought of this.
:mad:
This is generally how it is done in UHC nations. Reconstructive cosmetic surgery is included. With some differences. In the UK there are no deductibles, in Norway total deductibles are capped at about $ 250 per year etc.
I think you underestimate how much wastage, extra bureaucracy and duplication of work your current system involves. And it think you underestimate it by a very, very large amount.
Being a more populous nation does affect costs. It makes things cheaper. It is called the economics of scale and size. Its a known thing. However the rest of it…
If you are saying that violent crime, obesity and being used to healthcare quality on the bottom 25 % of the developed world (you seem to have misspelled that as “best in the world” ) are factors large enough to affect healthcare costs, and at this level, Im going to need to see some strong cites.